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General NPI Number Information
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NPI Number | 1598325573
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Entity Type | Individual
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Provider Name | CARA ALEXANDRA FOSSUM PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 201 JOHNSTOWN CENTER DR
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City | JOHNSTOWN
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State | CO
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Zip | 80534-9005
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Country | US
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Telephone | 970-587-1128
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 STRAUSS CABIN RD. 12-212
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City | FORT COLLINS
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State | CO
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Zip | 80528
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Country | US
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Telephone | 703-297-6903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0022861
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0022861
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License Number State | CO
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